Be Your Authentic Self: Part 2
PublishedOctober 3, 2021
Andrew Le, MD: Do you see digital health as a tool to help us do more to support the health of Black communities and communities of color?
Dr. Patrice Harris: The AMA and the CDC [Centers for Disease Control and Prevention] have both clearly identified racism as a public health issue. We need to continue conversations about how systems interact to impact health. We are used to communicating over Zoom now, but I think the difficult conversations need to happen in person. This is a complicated challenge that requires work on a lot of fronts.
A silver lining to the pandemic is that a lot of support groups and physician appointments moved to telehealth. That increased access to some sources of care. But a lot of folks in rural areas don't have broadband. Some folks in the inner city can’t afford a data plan. That’s the promise and the peril of digital health solutions.
Andrew: Absolutely. You have experience working with the AMA Opioid Task Force. How did the pandemic impact patients who are dealing with the opioid crisis? What can we learn from that moving forward?
Patrice: Unfortunately, pre-pandemic we saw an increase in opioid overdoses, mainly related to fentanyl. Some states also reported increased overdoses throughout the pandemic. Treatment and recovery services were disrupted, so people couldn't get to their usual sources of care or support.
Some states were very forward-thinking. They relaxed treatment rules. You could get three days’ worth of methadone, an approved treatment for opioid use disorder, instead of coming daily. If you were going to start buprenorphine, you didn’t need to have an in-person visit first. In needle exchange programs, maybe you could get five needles instead of one at a time. We still have a long way to go, but those are positive developments.
We use the term “overdose crisis” because it's not just opioids. It's methamphetamine and other substances. What we should be thinking about is a coordinated system that works for any substance use disorder.
Andrew: That makes sense. Are there further reforms you want to see at the state or federal level?
Patrice: One of the earliest things that CMS did for Medicare and Medicaid services during the pandemic was make the reimbursement equitable for a telehealth visit. That needs to continue and bring commercial payers along. It’s not pandemic-related, but the collaborative care model is a great for integrating mental health and primary care. We want those efforts to be adequately funded because there are just not enough psychiatrists, psychologists, and therapists.
We must have evaluation plans in place. I often say we need to inspect what we expect. Continuing pay equity for telehealth, and making digital care available, are both good. But we want to make sure we are getting good health outcomes so we can continue to do the things that are working and discontinue those things that don't work. We're not very good at that. Medical and public health professionals—and science in general—have been attacked this year. We must make sure that we are always following the evidence.
Andrew: I could not agree with you more.
Patrice: I encourage everyone, especially physicians, to think about whether we can communicate better. We must combat misinformation, of course, but how can all of us do a better job communicating about these complex topics?
What was frustrating to a lot of folks in this country was sometimes our recommendations changed. They said, "Two months ago you said don't wear a mask, and now you're telling me to wear a mask." We know exactly what happened. At the very beginning, masks were scarce, and we wanted to make sure that health professionals had them. But the moment we saw data about COVID-19 being airborne, we recommended masks for everyone. I was president of the AMA at the beginning of the pandemic and the chief spokesperson. Looking back, was I speaking in doctor-ese or too science-y? I think about how I can use language the public understands, so when I say something, they trust me.
Andrew: Speaking of self-awareness, what's brought you joy or peace during the pandemic?
Patrice: Spending time with my dad. Early on, just like everyone else in this country, we were not able to see older relatives because it was risky. I did not see my dad for about four months. It made me so joyous when I was able to see him. I have a very close-knit family, originally from West Virginia. My dad had nine siblings. I was an only child, but I grew up near a lot of my cousins. Family has always brought me joy.
I'm an optimistic person. Over the last year, I was not optimistic every day, but I chose to figure out the path forward. And I choose to do all that I can to move us on the path forward. At the end of the day if I have remained true to myself, if I have maintained my sense of integrity, and if I can face myself in the mirror about what I did or didn't do that day, then I am at peace.